There simply aren’t enough hours in the day for many family doctors to deliver high-quality care to people with chronic conditions
Thanks for the news flash. One helpful recommendation: “Ostbye’s team set forth a number of suggestions to ameliorate the problem, including writing patient care guidelines with real-world conditions in mind.
‘There is a lot to be said for having guidelines, but it seems they are often written in isolation.’”
Agreed. More of these academic physician-administrators needs to experience clinical medicine in the managed-care world. Like their views on primary care’s woes, they are so sheltered in an academic setting that they provide guidance that is not practical in real-life.
Related posts:
- Are academic physicians the next target on the inflated executive salary hit list?
- The micromanaging attending
- Staying human
- Evidence-based medicine is hard to implement
- Who monitors clinical guidelines?
- A cost effectiveness institute
- Medical guidelines
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Maybe. I don’t however believe I would call the leaders of academic medicine sheltered.
Physicians who dedicate themselves to academia suffer large pay discrepancies compared to their private practice counterparts. In clinical enviornments they see the worst cases, as the burden for teaching hospitals (already huge) continues to grow concerning care for the indigent. Meanwhile, medicare reimbursement issues and funding for research and training, put huge financial burdens, almost unparalleled in the private world, on teaching hospitals and any associated medical schools.
It is hardly sheltered. The real problem may be that these physicians, having given up the lure of higher earning power for a desire to train future physicians and help the truly needy, expect such altruism from their medical students as well. Apparently, that cannot be counted on. As you pointed out, the ‘R.O.A.D. to success’ seems to be the bottom line.
I am not so sure the discrepancies are all that great. Academic physicians have the benefit of working with residents who are able to provide considerable manpower to the efforts of the practice. As long as the physician is directly involved in the care the resident is providing, and documents his involvement, then he can also bill for the work done. (He can’t bill for work done solely by the residents, however, even though he does have liability for the residents he is covering). Much depends on how the particular physician’s position is funded, whether there is institutional support, research grant funding, affiliation with the VA or other government care facilities, insurance payor mix and the quality of the institution’s efforts to collect for work done. Some academic physicians do very well, better than private colleagues.
I went to a hematology conference not too long ago, at Rush, in Chicago. At some point I asked a very respected hematologist if he ever used old heparin injections for outpatient management of DVT and he told me “No” and could not give me any data or recent guidelines. A third of my patients can’t afford LMWH, imitrex, valtrex, coreg, lipitor, cipro, augmentin, combivent, advair…should I continue ?
And that’s the problem with the guidelines. Like the fashion show, it is not for the size 12-16 woman.
Just waiting for Pay for Performance to be used against the overworked FP in his clinic.
Say Dr. Tony, I notice on your site you’re a Certified IME.
Under which system are you certified?
Is the certification worthwhile for you? Like more consults, more recognition, etc.
I do occasional IME exams, wonder about doing more of it and pursuing one of the certification things out there.
The administrators in Work Comp, etc., generally tell me that certification does not make any difference to them, they just go by the doc’s underlying medical training, certification, etc. (at least in my area) Nevertheless, I wonder if the training and certification process might help to write better reports and all that.
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